Mail Order Millionaire
Order On-Line By Check!

Simply order online by using the information from your personal or business check. Or you can fax your check with your information to (502) 765-4894. After your payment information is received, a one-time bank draft will be created for the amount authorized by you in this order. Make sure to enter this check number, payee, and amount in your check register. PLEASE DO NOT USE THE SAME CHECK NUMBER TWICE. If you perfer, you can mail your order to: P.O. Box 25, Elizabethtown, KY 42702-0025. Please make checks and money orders payable to Jason Cannon. Thanks for your business! It's always appreciated.

 Your Information

Name
Business
Street address
Address (cont.)
City
State
Zip code
Phone
FAX
E-mail

How did you hear about us?

 Your Bank's Information

Bank Name
Bank address
Address (cont.)
City
State
Zip code
Phone

 Your Check's Information

example check

Check Number
Routing Number
Account Number
Branch Number

 Product Information

All prices include shipping and handling.

Total: $

 Authorization Section

Terms and Conditions
By checking this box I understand that due to any returned Check(s) "Drafts" because of NSF, Stop Payment (fraud), false information or any other acts deamed intentional by the customer, I, the said customer, may be assessed an additional $20.00 fee per incident.

Electronic Signature
By checking this box I understand that this is a check transaction, and I hereby authorize Jason Cannon to issue a check draft in the amount stated above. Checks will be made payable to Jason Cannon.

©1998 Jason Cannon